Jury finds serious failings by Belmarsh Prison led to killing of Sundeep Ghuman by racist cellmate

25 years after the murder of Zahid Mubarek, the inquest into the death of Sundeep Ghuman concluded on Friday 7 November at Southwark Coroner’s Court before HM Assistant Coroner David Manknell KC.

Sundeep, a British Asian man, died on 19 February 2020, following an extremely violent assault in HMP Belmarsh by his cellmate, Steven Hilden, who was a known racist. Hilden was overheard, while in Feltham YOI, telling other prisoners that he was a member of a racist gang that went on attacks in South London. He later volunteered this information to officers on arrival at HMPs Peterborough and Belmarsh in 2016. Sundeep had been recalled to prison in September 2019.

The assault occurred within the space of a few minutes on 18 February 2020 and involved the use of a table leg, resulting in unsurvivable head injuries. The evidence of Consultant Forensic Pathologist Dr Randall was that the injuries Sundeep sustained were commonly seen in road traffic collisions where there are serious violent high-speed forces being applied to the head.

The evidence heard during the inquest has revealed serious and systemic failings in the prison’s risk assessment and management processes, particularly in relation to the risk posed by racist prisoners. Despite Hilden’s recorded Alerts for violence and racism, officers conducting the Cell Share Risk Assessment assessed him as standard risk, meaning he could share a cell with anyone. This mistake was not picked up in the three months that followed, despite Hilden’s alleged involvement in an assault against another prisoner and heavy drug use, nor on 7 February when Hilden and his cousin were moved houseblocks and into Sundeep’s cell.

At the time of the assault, Hilden and Sundeep were sharing a cell with Hilden’s cousin who was later acquitted of his murder. The cell was originally intended to house two prisoners but had been sanctioned to hold three men due to capacity issues within HMP Belmarsh. This use of triple cells, which has been associated with increased violence, further exacerbated the risks to Sundeep.

The jury found that Sundeep Ghuman was unlawfully killed by his cellmate Steven Hilden while a prisoner at HMP Belmarsh. They also found that Hilden was a racist. The jury concluded that Hilden’s Cell Sharing Risk Assessment (CSRA) was not carried out appropriately for the following reasons:

1. The relevant policy clearly indicated that Hilden should have been classified as high risk with a note to share with only his own ethnicity due to evidence of racism.
2. Hilden’s racist alert was active on the prison system and should have led to him being assessed as high risk.
3. Belmarsh did not properly consider the paper CSRA from his previous prison or his prison notes prior to completing their own assessment.

The jury found that had the CSRA been properly conducted, Sundeep would not have been placed in a cell with Hilden and his death could therefore have been avoided. They found that the prison’s failure to assess the risk posed by Hilden’s racism materially contributed to Sundeep’s death.

The prison also failed to consider the additional risks posed by placing three men in a cell, including possible increased tension and potential imbalance in relationships this may cause. However, they noted that officers were not expected to assess these risks as the relevant policy did not cater for triple occupancy cells, and they could not say whether this contributed to Sundeep’s death.

Finally, the jury concluded that the lack of efficacy in the CSRA process, including the inadequate training of prison officers and their poor understanding and application of the relevant policy, contributed to Sundeep’s death.

HM Assistant Coroner David Manknell KC indicated that he will be issuing a Prevention of Future Death (Regulation 29) report, addressing the following concerns:

• The operation and application of the CSRA process at HMP Belmarsh and more widely within the prison estate
• The lack of consideration of risks beyond the minimum CSRA requirements.
• The absence of guidance on how NOMIS alerts for racism should be treated.
• Prisoner safety at HMP Belmarsh given the evidence of widespread violence and drug use.

It is deeply concerning that the very systems introduced following the racially motivated murder of Zahid Mubarek in 2000, failed to protect Sundeep Ghuman twenty-five years later. The similarities between the two cases are striking and troubling. Both involved prisoners with known racist views and histories of violence, placed in shared cells with individuals from ethnic minority backgrounds, without adequate safeguards.

This inquest has highlighted the urgent need for an overhaul in the way prisons assess and manage risks related to racism and violence. It is unacceptable that, over two decades after Zahid Mubarek’s death, the same institutional failures could contribute to another preventable tragedy.

Jo Eggleton, of Deighton Pierce Glynn, who represents Sundeep’s family, said: “It was shocking to discover during the inquest that officers at HMP Belmarsh were still not classifying men with a known history of racism high risk, as required by the policy, introduced following Zahid’s murder. Had they been conducting the mandatory checks this would have been discovered years earlier.”

Jodie Anderson, Senior Caseworker at INQUEST said: “The similarities between Sundeep’s and Zahid’s murders, some twenty-five years apart, are a deeply disturbing indictment of the myth of prison reform. The far-right are increasingly emboldened by reactionary, populist politics which fan the flames of racial hatred. Prisons are a microcosm of society, and Sundeep was the human cost of a system that turned a blind eye to racism and hate. The Ministry of Justice and HMPPS fought tooth and nail throughout this inquest to remove any mention or scrutiny of race and racism from the jury’s consideration. Such tactics undermine the supposed “non-adversarial” nature of a process intended to uncover the truth. We know that the preventative function of inquests can only be performed once a bright light has been shone on the State’s darkest corners.”

NOTES TO EDITORS

For further information, please contact Leila Hagmann on leilahagmann@inquest.org.uk or 020 7263 1111.

Other Interested Persons at the inquest are HMP Belmarsh, Oxleas NHS Foundation Trust and Practice Plus Group.

Journalists should refer to the Samaritans Media Guidelines for reporting suicide and self-harm and guidance for reporting on inquests.